Cirrhosis

Background

• A generally irreversible fibrotic scaring of the liver parenchyma resulting in liver failure
• The twelfth leading cause of death in men and women in 2013

Clinical Features

Child-Pugh Score[2]

	+1	+2	+3
Bilirubin	<2mg/dL	2-3 mg/dL	>3 Mg/dL
Albumin	>3.5 mg/dL	2.8-3.5 mg/dL	<2.8mg/dL
INR	<1.7	1.7-2.2	>2.2
Ascites	No ascites	Ascites, medically controlled	Ascites, poorly controlled
Encephalopathy	No encephalopathy	Encephalopathy, medically controlled	Encephalopathy, poorly controlled

• Score ≤ 7 = Class A = 100% and 85% one and two-year patient survival
• Score 7 - 9 = Class B = 80% and 60% one and two-year patient survival
• Score ≥ 10 = Class c = 45% and 35% one and two-year patient survival

MELD Score[3]

MELD-Na Score	3-month mortality
40	71.3%
30-39	52.6%
20-29	19.6%
10-19	6.0%
<9	1.9%

Differential Diagnosis

• Hepatitis chronic B and C
• Alcoholic liver disease
• Non-alcoholic steatohepatitis
• Drug induced (ie. Tylenol. amiodarone, NRTIs])
• Cardiac Cirrhosis
• Primary biliary cirrhosis
• Primary sclerosing cholangitis
• Autoimmune Hepatitis
• Alpha1 anti-trypsin Deficiency
• Cystic Fibrosis

Management

Complications of cirrhosis

• Ascites
• Esophageal varices
• Hepatic encephalopathy
• Spontaneous bacterial peritonitis
• Hepatorenal syndrome
• Portal hypertension
• Hepatocellular carcinoma

Disposition

• Often complex and should be based on presence/absence of acute complications
• If no complications present, discussion with patient's primary care provider or gastroenterologist recommended

See Also

• Viral hepatitis
• Acute hepatic failure
• Jaundice